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What’s the Difference? Pre-hospital Different Mechanisms: Things children do and their changing levels of maturity predispose them to different injury patterns. Different Injuries: When involved in the same kind of accident as adults, children suffer quite different injuries.

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The ABCDE of Pediatric Trauma Application of a systemic protocol designed to standardize diagnostic and treatment decisions so that individual variations in patterns of injury do not distract the caregivers from recognizing and treating injuries that can have a profound impact upon outcome.

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Considerations When and When not to intubate. O2 Sat <95% =clinical hypoxia Assess airway (teeth, debris,blood) Neurologically intact and phonates normally, and ventilates without stridor then leave them alone and monitor only. Coma, combativeness, shock, or direct trauma then needs a tube.

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Pediatric Intubation Children’s airways differ both anatomically and physiologically. The best trained should intubate. Have appropriate equipment and medication available for best results.

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Intraosseous Line Less than 6 years of age Fluids, blood products, and drugs can be given Proximal tibia or distal femur best location Fracture of the bone only contraindication Obtain alternate access ASAP

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Other thoughts Gastric dilatation-NG tube –respiratory compromise and vagal bradycardia. Decreases risk of aspiration. –no if facial fx or rhinorhea Foley only after perineal assessment ECG-rarely abnormal but if it is then multiple possibilities.

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Secondary Decreased cerebral perfusion after the event –brain swelling leads to impairment of O2 and substrate. –treatment principle is to protect cerebral perfusion and is the difference between disaster and success. CPP=MAP-ICP

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Pulmonary Contusion Commonest Injury Rare to need ventilation Rare to go on to ARDS Differentiate from Aspiration Most clear in 7 to 10 days.

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Trachea and Bronchi Rare but often fatal Presentation-Voice disturbance, cyanosis, hemoptysis, Massive sub Q air and mediastinal emphysema Large leak from chest tube. ATLS and then OR unless stable

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Heart and Pericardium Concussion –commotio cordis Contusion-commonest and difficult to diagnosis (rarely of clinical significance in children) Myocardial rupture-commonest cause of death in blunt trauma. (if survive may see tamponade.)

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Traumatic Asphyxia Unique to Children Compression of Chest and/or Abdomen against a closed glottis Increase in intrathoracic pressure leads to increase in the SVC pressure and the veins from the upper body that drain into it. Extravasation of blood into skin, sclera, brain Seizures, disorientation, petechiae of upper body and conjunctivae Most recover

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Case Study: BF 15 y/o male presents to OSH after he was hit with a line drive while playing indoor baseball C/O pain to R abdomen/rib/flank Pain is getting progressively worse and patient is now vomiting

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Case Study BF: Disposition Patient was treated non-operatively He remained in Pediatric ICU for 2 days, and was transferred to the peds floor for 4 more days. Was discharged on day 6; home care included bedrest for 1 month and no school